System and Method for Acquiring Images of Medication Preparations

ABSTRACT

A system for holding a camera for acquiring images of preparations includes a rail that can be mounted above a preparation surface. A camera carrier couples a camera with the rail such that the camera is movable relative to the rail and such that the camera can acquire images of preparations on the preparation surface.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.13/097,575 entitled “System and Method for Acquiring Images ofMedication Preparations”, filed Apr. 29, 2011, which claims priority toU.S. Provisional Patent Application No. 61/330,146 titled “System andMethod for Acquiring Images of Medication Preparations”, filed Apr. 30,2010, the contents of which are hereby incorporated by reference intheir entirety.

BACKGROUND Field

The present disclosure relates to pharmacy services, and morespecifically, to a method and a system for acquiring and using images ofpreparations of substances. More particularly, the present disclosurerelates to acquiring and using images of medication preparations.

Description of the Related Art

A pharmacist's scope of practice in institutions, such as hospitals, orcorrectional facilities, includes preparing, packaging, compounding, andlabeling medication, compounding sterile products, as well as othermedication related activities. Many technical functions involving thepreparation and distribution of drugs may be performed in theinstitution by non-pharmacist personnel, usually a pharmacy technician,licensed nurse, pharmacy student, pharmacy intern, nursing student ortrainee, or a pharmacy technician student or trainee. When anon-pharmacist (such as a technician) performs such functions, or when apharmacist performs such functions involving high cost and/or high riskmedications, a pharmacist must generally verify their work.

When technical pharmacy functions are performed (whether by apharmacist, or a non-pharmacist, such as a nurse), a pharmacisttypically verifies the work, in part, by comparing it to either a copyof the original medication order, or a medication order previouslyentered into the patient's medication profile. The pharmacist alsosupervises the work of the non-pharmacist, and verifies that themedication product has been correctly and accurately prepared, labeled,compounded, and/or packaged. When a non-pharmacist performs technicalpharmacy functions involving prepackaging, labeling, bulk compounding,or batch preparation of medications that will serve as stock medicationin the pharmacy department, a pharmacist must generally verify the workin much the same manner. The pharmacist must supervise the work of thenon-pharmacist to verify that the medication has been correctly andaccurately prepared, labeled, compounded, and/or packaged.

Preparation of medications typically involves several steps. Typically,a medication order, such as an order for a prescription drug or stockrequisition, is delivered to a technician. The technician prepares themedication based on the specifications of the order, and according to anestablished protocol. The technician's work in preparing the medicationis supervised and approved by a pharmacist.

Direct and personal oversight and approval by a pharmacist forpreparation of medications is typically required, for example, underpharmacy laws and regulations of various states. In some cases, however,the pharmacist may not be at the facility where preparation of themedication occurs, or may be in the facility but not in an area enablingphysically present direct supervision of the preparation of themedication. In such cases, approval may sometimes be carried out throughthe transmission or exchange of information such as photographs of thepreparation at various stages and/or videoconferencing between thetechnician and the pharmacist.

Some preparation facilities have a camera that can be used to takephotographs of various stages in the preparation of a medication. Imagedata from the camera may be transmitted (for example, over a computernetwork) to a remote location where the supervising pharmacist is. Atthe remote location, the pharmacist may use the photographs to monitorthe preparation of the medication and notify the technician of thepharmacist's approval. Many existing cameras, however, are not suitablefor a sterile medical environment. For example, many cameras have bases,stands, tripods, platforms, cables, or exterior surfaces of the camerathat cannot be effectively sterilized without damaging the camera orrelated equipment. In addition, positioning the camera and managing theimage data produced by the camera may be cumbersome and time-consuming,especially in facilities where multiple preparations are occurring atthe same time.

Managing workflow and keeping track of the photographic data may also bedifficult for technicians working with an off-site pharmacist,especially when multiple preparations are occurring simultaneously atthe same preparation facility, or when one remote pharmacist isoverseeing many preparations at more than one preparation facility.

SUMMARY

Systems and methods are described herein for acquiring and using imagesof preparations, such as medication preparations. According to oneembodiment, a system for holding a camera for acquiring images ofpreparations includes a rail that can be mounted above a preparationsurface. A camera carrier couples a camera with the rail such that thecamera is movable relative to the rail and such that the camera canacquire images of preparations on the preparation surface. In someembodiments, the surface and the camera carrier are in a sterileenvironment. In certain embodiments, the system is mounted in a hood.

According to one embodiment, a system for holding a camera for acquiringimages of preparations includes a camera carrier that holds the cameraabove a preparation surface. A camera case houses the camera andprotects the camera during cleaning of the workstation. A wirelessdevice may transmit information between the camera and one or morecomputer systems.

According to one embodiment, a system for acquiring images ofpreparations includes a camera and a wireless transmitter. The wirelesstransmitter sends information from the camera to a computer system.User-operated triggers external to the camera can be used to control oneor more functions of the camera (such as taking photos). In someembodiments, external manual triggers are provided on a case that can bewiped down during cleaning of a workstation.

According to one embodiment, a method of acquiring images ofpreparations includes capturing, with an image capture device, one ormore images of at least one stage of a first preparation at a firstzone. The image capturing device may be moved to point at a second zone.Images may be captured of at least one stage of a second preparation atthe second zone. In some embodiments, a sterile environment is createdand maintained in the zones during the making of the preparations.

According to one embodiment, a method of acquiring images ofpreparations includes placing an identifier code (such as a semacode)with a preparation. Images are captured of at least one stage of thepreparation. The identifier code is visible in the images. Theidentifier code is automatically read from the images. The identifiercode in the image is used in the evaluation of the preparation (such asby associating all the images for the preparation with one another basedon the identifier code, or prioritizing the preparation overpreparations having other identifier codes). In some embodiments, theorder of workflow may be based on the identifier codes for differentpreparations.

According to one embodiment, a method of making a preparation includesplacing a preparation identifier code (such as a semacode) with thepreparation. In addition, identifier codes (such as a one-dimensional(“1D”) barcode) on the ingredients are also visible in the work area.Images are captured of at least one stage of the preparation. Thepreparation identifier code and the ingredient identifier codes arevisible in the images. The identifier codes are automatically read fromthe images. The identifier codes in the image are used to verify thatthe correct ingredients are being used for the preparation. If thecorrect ingredients are not used, a warning device can warn one or moreparticipants involved in preparing the medication.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a block diagram of one embodiment of a networkedenvironment suitable for implementing remote supervision andverification of pharmacy functions.

FIG. 2 illustrates one embodiment of a workstation including a movableimage capture device.

FIG. 2A is a detail view illustrating elements that can be captured inan image of pharmacy work for remote supervision and verification,according to one embodiment.

FIG. 3 illustrates one embodiment of a workstation including a hood.

FIG. 4 illustrates an embodiment of a workstation having inductivecoupling for transmitting power through a hood.

FIG. 5 illustrates one embodiment of a camera assembly for aworkstation.

FIG. 6 illustrates an embodiment of a camera assembly in which thecamera case has been removed.

FIG. 7 is a cross sectional view of a bearing race assembly on a railaccording to one embodiment.

FIG. 8 illustrates one embodiment of a power connection between a railand a camera assembly.

FIG. 8A is a perspective view illustrating the interior of a passage fora rail according to one embodiment.

FIG. 9 is an exploded view of a camera assembly.

FIG. 10 is a schematic diagram illustrating one embodiment of a systemincluding an image capture device with a wireless transmitter/receiver.

FIG. 11 illustrates sequentially capturing image data for two or morepreparations according to one embodiment.

FIGS. 12A-12G is a schematic diagram illustrating one embodiment ofacquiring images for multiple preparations at a workstation.

FIG. 12Y illustrates one embodiment of verifying ingredients of apatient preparation by comparing barcodes in an image.

FIG. 13 illustrates one embodiment of an exemplary remote pharmacistworkstation.

FIG. 14 illustrates an exemplary system for remotely supervising andverifying pharmacy functions, according to one embodiment.

FIG. 15 is a flowchart illustrating a method for remotely supervisingand verifying pharmacy functions, according to one embodiment.

FIG. 16 is a block diagram illustrating a server facilitating remotesupervision and verification of pharmacy functions, in one embodiment.

FIG. 17 is flowchart illustrating one embodiment of a method forutilizing a network accessible server for remote supervision andverification of pharmacy functions.

FIG. 18 is a block diagram illustrating an exemplary computer systemsuitable for implementing remote supervision and verification ofpharmacy functions, according to one embodiment.

While the invention is described herein by way of example for severalembodiments and illustrative drawings, those skilled in the art willrecognize that the invention is not limited to the embodiments ordrawings described. It should be understood, that the drawings anddetailed description thereto are not intended to limit the invention tothe particular form disclosed, but on the contrary, the intention is tocover all modifications, equivalents and alternatives falling within thespirit and scope of the present invention as defined by the appendedclaims. The headings used herein are for organizational purposes onlyand are not meant to be used to limit the scope of the description orthe claims. As used throughout this application, the word “may” is usedin a permissive sense (i.e., meaning having the potential to), ratherthan the mandatory sense (i.e., meaning must). Similarly, the words“include”, “including”, and “includes” mean including, but not limitedto.

DETAILED DESCRIPTION OF EMBODIMENTS

As used herein, a “preparation site” includes any facility, room, space,or location that can be used to make preparations. In some embodiments,a preparation site is an institutional pharmacy, such as a pharmacy at ahospital or a correctional facility. In various embodiments, apreparation site may be at an educational facility (such as a pharmacyschool), a clinic (such as an outpatient clinic), a laboratory (such asa lab in a teaching facility), a nursing floor in a hospital, or otherlocation. In some embodiments, a preparation site is in a sterileenvironment. In other embodiments, a preparation site is in anon-sterile environment.

As used herein, a “workstation” includes any station, system, apparatus,space, facility, or combination thereof at which medications ormedication orders and/or requisitions can be prepared or chemical mixingprocedures can be performed. In some embodiments, a workstation mayallow for multiple preparations to be prepared simultaneously. In someembodiments, a workstation may have two or more substations at whichmedications can be prepared. A workstation may accommodate activities bymore than one worker at a time.

As used herein, “medication” means any chemical, composition, orcombination thereof, that can be used for treatment, diagnosis, orprevention of disease. A medication may be, for example, a drug capsulethat is to be taken by a patient, such as an antibiotic or chemotherapydrug.

As used herein, “chemical mixing procedure” means any procedure thatincludes mixing, dissolving, or otherwise combining chemicals,compositions, or materials. A chemical mixing procedure may include, forexample, the mixing of compositions for pharmaceutical applications,such as in the making of prescription drugs.

As used herein, “image” includes a still image (such as a stillphotograph), a moving image or images (such as video), and combinationsthereof. As used herein, a camera includes any device or combination ofdevices that can capture images. A camera may be a still camera or avideocamera.

As used herein, a “rail” includes any member that allows another elementto slide or translate along its length. A rail may have various formsincluding a rod, a bar, a beam, or a plate. A rail may be straight,curved, or a combination thereof. A rail may have any cross section,including round, square, rectangular, ovate, or irregular. The crosssection of a rail may vary over the length of the rail.

As used herein, a “hood” includes any enclosure or partial enclosurethat at least partially inhibits contamination in at least a portion ofa work area or that contains fumes or liquids from a chemical mixingprocedure.

As used herein, “clean zone” means a space or area that is kept cleanfor purposes of making preparations. A clean zone may include one ormore barriers for keeping contaminants out of the zone. In someembodiments, a clean zone is the interior of a hood. In someembodiments, a clean zone is periodically cleaned or sterilized. As usedherein, “clean zone” does not require that an area be entirely free ofcontaminants.

As used herein, “sterile environment” includes an environment in whichbiological and particular matter are filtered or excluded withinacceptable limits.

As used herein, “target zone” means an area where an imaging device ispointed. A target location may be, for example, a portion of the topsurface of a table at which a camera is aimed.

As used herein, a “table” includes any structure or element having asurface on which medications can be prepared or chemical mixingprocedures can be carried out. A table may have legs or other supportsfor holding the working surface. A table may supported by anotherstructure, such as an adjacent wall.

As used herein, “target indicating device” includes any device thatprovides an indication of a target zone of a camera. A target indicatingdevice may, for example, be a projection device, such as a laserpointer, that projects a frame onto the surface of a table. The imageactually taken by a camera may vary from the indicators provided by thetarget indicating device. For example, a target indicating device mayproject a frame that is smaller than the image actually taken by acamera.

As used herein, “trigger” includes any element or device that causessomething to happen, such as activating, switching, or releasing adevice. For example, a trigger may activate a shutter on a camera. Asanother example, a trigger may change the state of a switch (such ason/off) or change a setting on a device. A trigger may include variousdevices, including an electronic switch, a push button, a lever, athumbwheel, or a knob. A trigger may work in combination with otherelements, such as levers, cables, wheels, gears, rods, cams, or othermembers. In certain embodiments, a trigger may be implemented through acommand from a computer system. In certain embodiments, a trigger may beautomatic.

Pharmacy functions (which may be performed by a pharmacist, or by anon-pharmacist such as a technician, nurse, pharmacy intern, or astudent) may be remotely supervised and verified by a remote pharmacistusing a networked environment, such as illustrated by FIG. 1, accordingto some embodiments. Pharmacists at one or more remote pharmacist sites110 may remotely supervise and verify pharmacy work tasks performed bypersonnel at one or more preparation sites 120, according to someembodiments. Remotely supervised and verified pharmacy work tasks mayinclude pharmacy functions performed pursuant to medication orders andmay also include pharmacy functions not related to specific medicationorders, according to various embodiments. In general, the term “pharmacywork task” as used herein may describe any pharmacy functions capable ofbeing remotely supervised and verified by the methods and systemsdescribed herein, whether or not performed pursuant to a medicationorder.

As illustrated in FIG. 1, a remote pharmacist site may be linked to oneor more preparation sites while located remotely from the preparationsites. For instance, preparation site 120 and remote pharmacist site 110may be located in different parts of the same building, in oneembodiment. In other embodiments, however, preparation site 120 andremote pharmacist site 110 may be in different buildings of the sameinstitution, in the same town, in different cities, counties, or states.In general, remote pharmacist site 110 and preparation site 120 may belocated anywhere as long they can communicate with each other eitherdirectly or indirectly.

Remote pharmacist site 110 and preparation site 120 may communicate viaany of various wired or wireless communication systems, according tovarious embodiments. For example, in one embodiment, they maycommunicate via email over the Internet. In another embodiment, they maycommunicate via a custom communication protocol configured forexchanging messages related to remotely supervising and verifyingpharmacy functions, such as may be implemented by remote verificationsoftware 140, as will be discussed herein below. In yet anotherembodiment, remote pharmacist site 110 and preparation site 120 maycommunicate via a website or electronic bulletin board, such as systemwebsite 130, by uploading and downloading various documents, imagesand/or other information related to remotely supervising and verifyingpharmacy functions. Additionally, remote pharmacist site 110 maycommunicate with a pharmacy order entry system or other software atpreparation site 120 via an Internet connection, virtual privatenetwork, or any wired or wireless link, according to one embodiment. Forexample, a pharmacist at remote pharmacist site 110 may communicate withsuch an order entry system or other software at preparation site 120 inorder to verify a patient's medication order.

As illustrated by FIG. 1, multiple remote pharmacist sites 110 may existin the system at once, as well as multiple preparation sites 120,according to some embodiments. A single remote pharmacist 110 mayremotely supervise and verify pharmacy functions performed at more thanone preparation sites 120. Additionally, a pool of remote pharmacistsites 110 may work together to remotely supervise and verify pharmacyfunctions performed at multiple preparation sites 120, in someembodiments. For example, a number of remote pharmacist sites 110 mayeach remotely supervise and verify pharmacy functions for any of anumber of preparation sites 120 on a rotational or as needed basis. Forinstance, in one embodiment, a pharmacist at remote pharmacist site 110may check and/or verify images from one or more preparation sites 120randomly chosen out of a number of available preparation sites 120. Inanother embodiment, a remote pharmacist site may remotely verifypharmacy functions performed at a number of preparation sites on afirst-come first-served basis in which the preparation sites areserviced in the order they notified the remote pharmacist that imageswere available for verification.

According to some embodiments, pharmacy functions performed atpreparation site 120 that may be remotely supervised and verified mayinclude, but are not limited to:

-   -   1. Packaging, prepackaging and labeling unit and multiple dose        packages.    -   2. Medication preparation, packaging, compounding or labeling        pursuant to medication orders.    -   3. Compounding of sterile pharmaceuticals pursuant to medication        orders.    -   4. Bulk compounding or batch preparation.

The terms prepackaging and packaging, as used herein, may refer to twodifferent pharmacy functions. Prepackaging refers to the re-packagingand/or re-labeling quantities of drug products from a manufacturer'soriginal commercial container, such as into a prescription container fordispensing. Packaging, on the other hand, refers to collecting one ormore medications into a final package to be dispensed to the ultimateconsumer. For example, packaging may refer to a technician selectingappropriate quantities of manufacturer's unit dosed products and/orprepackaged stocked medications necessary to fill a patient's admissionorders. The technician may then package the selected medications into abag with an affixed label indicating the patient for whom themedications were ordered. As with other pharmacy functions, theprepackaging and the final packaging of medications may be remotelysupervised and verified by a pharmacist, as described herein.

Remote verification of pharmacy functions performed by non-pharmacistsmay additionally include, in some embodiments, one or more legallyrequired in-progress checks. In general, remote pharmacist verificationof pharmacy work performed by non-pharmacists may include supervisionand/or verification of the pharmacy work in various stages of completionas well as verification of any and/or all results of the pharmacy work,according to various embodiments.

A preparation site 120 may be a pharmacy located in an institution, suchas a hospital or correctional facility. In general, preparation site 120may be any pharmacy that cannot or does not have a pharmacist on site atall times. As illustrated in FIG. 1, preparation site 120 may be linkedto a system website 130 and/or one or more remote pharmacist site(s) 110via any of a number of ways, such as over the Internet, a virtualprivate network, or, in general, any wired or wireless communicationsystem configured to allow the exchange of information related to remotesupervision and verification of pharmacy functions, as described herein.For instance, preparation site 120 may communicate with remotepharmacist site 110 over network 100, which may be the Internet in oneembodiment. In other embodiments, preparation site 120 may communicatewith remote pharmacist site 110 directly over a telecommunicationssystem, such as the Public Switched Telephone Network (PSTN) or over acellular or satellite telecommunications system.

In some embodiments, system website 130 may represent an electronicbulletin board, or other shared electronic data storage facility, towhich images, documents, and/or other files may be posted, uploaded, orotherwise stored. Images uploaded or posted to a web site or bulletinboard may be compressed, encrypted, or combined (either compressed oruncompressed) into a single file, according to various embodiments. Forexample, in one embodiment, captured images may be uploaded in anencrypted form and a key or password to decrypt the images may beprovided to a remote pharmacist in a separate communication.Furthermore, system website 130 may require secure login credentials,such as a username and password, before allowing images to be uploadedor accessed. Alternatively, a public/private key encryption schema maybe utilized to ensure the security of the captured images in someembodiments. For example, the captured images may be encrypted using theremote pharmacist's public encryption key and may be decrypted by thepharmacist using the pharmacist's private encryption key. Additionally,any of various forms of secure electronic communication may be utilizedto transfer the captured images in some embodiments. For example, in oneembodiment, one or more images of pharmacy work may be transferred tosystem website 130 via a secure http protocol, such as HTTPS. In yetother embodiments, captured images may be digitally signed using digitalcertificate technology. For instance, the images may be digitally signedusing the preparations site's digital signature or certification which aremote pharmacist may verify using an appropriate digital certificationauthentication authority. As encryption, secure electroniccommunication, and digital signature and certificate technologies arewell understood in the art, they are not discussed in detail herein.

When personnel, such as pharmacy technicians, licensed nurses, pharmacystudents, pharmacy interns, nursing students or trainees, and/orpharmacy technician students or trainees perform pharmacy functionsrequiring the supervision and verification of a pharmacist, (forexample, in the absence of an on-site pharmacist), a still image capturedevice can be used to capture one or more images of the pharmacy workperformed. The captured images may, in some embodiments, include imagesof all work and documentation required to properly supervise and verifythe correct and accurate preparation, labeling, compounding,prepackaging and/or packaging, of any pharmacy work performed. Thecaptured images may also include any additional documentation requiredfor record keeping purposes, in some embodiments. In some embodiments,the captured images, exchange messages, and related documentation arecompiled and stored as a permanent record for a preparation. Multipleimages may be captured for remote supervision and verification processas needed, according to some embodiments. For example, if alldocumentation and materials required for the pharmacy work do not fit inthe view of an image capture device, two or more images may be captured.

Preparation Workstation

In some embodiments, a preparation site, such as a pharmacy, includesone or more preparation workstations. A preparation workstation may beused to implement remote supervision and verification of pharmacyfunctions, as described herein. In some embodiments, a workstation areais in a sterile environment.

As discussed above, a supervising pharmacist may, in some cases, be in aseparate location from the preparation workstation. In some cases,however, a supervising pharmacist may be at the same facility, but in anon-sterile part of the facility (for example, in the room next door toa lab where the workstation is located). Thus, for example, a pharmacytechnician student may make medication preparations in a sterileenvironment while a pharmacist supervises the preparation in anon-sterile environment. Allowing the pharmacist to be in a non-sterileenvironment may relieve the pharmacist of having to take specialprecautions to maintain a sterile environment.

In some embodiments, an image capture device is suspended above a workarea for preparations. Suspending an image capture device above a workarea may eliminate some components that may be difficult to sterilizeeffectively (such as the legs of a tripod or base for a camera).

FIG. 2 illustrates one embodiment of a preparation workstation includinga movable image capture device. Workstation 200 includes table 202, railsupport assembly 204, rail 206, and camera assembly 208. Rail supportassembly may be coupled to table 202. Rail support assembly 204 supportsrail 206. Camera assembly 208 may slide along rail 206. Camera assembly208 may include a camera that is aimed downwardly toward table 202. Thecamera may acquire images of objects on table 202. The images acquiredby the camera may include, for example, still images, short video clips,or live video feeds, or combinations thereof. For example, with thecamera assembly positioned as shown in FIG. 2, the camera may acquireimages of objects that are within zone 210 on table 202. As cameraassembly 208 translates to the left or to the right on rail 206, thetarget zone of the camera may move correspondingly to the left or to theright. Thus, camera assembly 208 can be positioned to capture images indifferent areas on table 202.

Table 202, as well as the other components of workstation 200, may besupported on legs 212. Elements of a workstation may, however, besupported in any suitable manner. For example, a rail support assemblyand/or table for a workstation may be mounted on a wall. In otherembodiments, a workstation may be free-standing. In one embodiment, aworkstation may be supported on a countertop. In certain embodiments,elements of a workstation may be supported on a rolling cart.

Workstation 200 includes computer system 214. Computer system 214 mayinclude processing unit 216, monitors 218, keyboard 220, mouse 222, andfoot pedal switch 223. In certain embodiments, a workstation includes ahand-operated switch in addition to, or instead of, foot pedal switch223. Keyboard 220 and mouse 222 may rest on tray 224. The variouscomponents of computer system 214 may be connected to processing unit216 by cables (for clarity, cables are not shown in FIG. 2) or bywireless connections. In certain embodiments, a workstation may includea printer, scanner, telephone, facsimile machine, and various otherperipheral devices. Foot pedal switch 223 may be coupled to computersystem 214, camera assembly 208, or both. Foot pedal switch may beoperable by a user to control functions in camera assembly 208 orrelated to preparations (for example, uploading images acquired usingcamera assembly 208 to a pharmacist on a remote computer system).

Electrical devices in camera assembly 208 may be coupled to computersystem 214 and/or other systems. Camera assembly 208 may be connected byway of cables that are carried in cable routing 230. In someembodiments, cables in cable routing 230 may carry signals, data, and/orpower. Cable routing 230 may uncoil as necessary depending on theposition of camera assembly 208 along rail 206.

FIG. 2A is a detail view illustrating elements that can be captured inan image of pharmacy work for remote supervision and verification,according to one embodiment. Some or all of the elements may have abarcode on them. The barcode may be, for example, part of theirpackaging, or added to the elements. When a non-pharmacist workerproduces pharmacy work, such as pursuant to a medication order or otherpharmacy work task, one or more images of the pharmacy functionsperformed may be captured by an image capture device, such as cameraassembly 208. For instance, after performing a pharmacy functionrequiring supervision and verification by a pharmacist, thenon-pharmacist worker may move the job to a position at the workstationso that all materials and documentation required to properly superviseand verify correct and accurate preparation, labeling, compounding,prepackaging and/or packaging performed during the pharmacy functionsare captured in by the image capture device. For example, in oneembodiment, a non-pharmacy worker may perform one or more pharmacyfunctions and may capture images of the materials used, such as medicinevials 225, syringes 226, intravenous product 227, and documentation 228and 230, as illustrated in FIG. 2A. In some embodiments, several imagesmay be captured as the work is performed, each capturing a differentstage of the pharmacy work being performed. Additionally, one or moreimages may be captured of the completed work. In some embodiments, theworker may move and display the materials and documentation for imagecapture, while in other embodiments, images may be captured of thematerials and documentation in place as they are used during theperformance of pharmacy functions.

In some embodiments, making and evaluating preparations may includecreating and maintaining a sterile environment. A workstation may insome embodiments include a sterile environment. In some embodiments, aworkstation includes a hood. The hood may avoid contamination ofpreparations at the workstation. Technicians and other personnel at ornear the workstation may wear gloves, masks, head covering, and clothingthat are sterile and suitable for use in a sterile environment.

FIG. 3 illustrates one embodiment of a workstation including a hood.Workstation 232 includes table 202, hood 234, and mounting brackets 236.Rail mounting brackets 236 may be coupled to the upper wall of hood 234.In some embodiments, rail mounting brackets 236 couple to existingmounting hardware in a hood. In certain embodiments, a rail mountingbrackets 236 are designed to fit to existing mounting hardware in avariety of hoods (for example, standard, commercially available hoods).Rail mounting brackets 236 may carry rail 206. Camera assembly 208 maymove along rail 206. Power cable 238 may supply power to camera assembly208. In some embodiments, power is carried from cable 238 to cameraassembly 208 through conductors in rail 206. Power switch 239 may beprovided on power cable 238. Power switch 239 may be manually operatedby a user to turn power to camera assembly 208 on and off. In certainembodiments, power conductors to the rail may be routed through the endof the rail (for example, through sealed contacts in the bracket at theend of the rail), such that there are no power cables or wires exposedin the hood. Having power transmitted through a rail, rather than cablesrouted externally to the rail, may make cleaning procedures in the hoodeasier and more effective. In certain embodiments, a transmission systemmay transmit signals or data by way of rail conductors, in addition to,or instead of, transmitting electrical power.

In some embodiments, power cable 238 consists of a flat electricalcable. The electrical cable may be sandwiched between two layers of PVCTape. The electrical cable can also be routed in-between a sealinggasket and sealing surface to provide power without compromising thehood's sterile environment. In certain embodiments, the electrical cableis adhered to the hood wall, which may facilitate cleaning.

In some embodiments, electrical power is transmitted into the interiorof a hood without any openings in the hood. FIG. 4 illustrates anembodiment of a workstation having inductive coupling for transmittingpower through a hood. Workstation 240 includes table 202, hood 234,mounting brackets 242, and inductive coupling device 244. Rail mountingbrackets 242 may mount to hood 234. Mounting brackets 242 may supportrail 206. Camera assembly 208 may move along rail 206.

One half of inductive coupling device 244 is mounted on each side of awall 247 of hood 204. Inductive coupling device 244 may transmit powerto electrical devices in camera assembly 208. Cable 246 may carryconductors that transmit power from outside hood 234 to inductivecoupling device 244. Cable 248 may include conductors that transmitpower between inductive coupling device 244 and rail 206. In certainembodiments, an inductive coupling may carry data and/or signals toand/or from a camera assembly.

In some embodiments, an image capture device includes a camera foracquiring images of stages of a medication preparation. The images maybe include, for example, still photographs, video clips, or live videofeeds. FIG. 5 illustrates one embodiment of a camera assembly for aworkstation. FIG. 5 shows a camera as viewed from generally below thecamera as installed on a rail. Camera assembly 208 includes camera 250,case 252, release 254, and indicating devices 256. Case 252 may protectcamera 250 from exposure to elements at a workstation, such as fumes andsplashed liquids. A camera case may include, for example, gaskets andother seals. Case 252 may facilitate cleaning of a workstation. Forexample, in some embodiments, the camera assembly may be sterilized bywiping down the camera case with a bleach solution. In certainembodiments, a case for a camera is splash resistant.

Hole 258 passes through the camera assembly 208. Hole 258 mayaccommodate a rail, such as rail 206 shown in FIG. 2. Camera assembly208 may slide along rail 206. Camera case 252 includes handle 260.Handle 260 may be grasped by a technician to move camera assembly 208along the rail.

As noted above, camera assembly 208 includes release 254. Release 254may be spring loaded. Camera case 208 may remain fixed on the rail untilrelease 254 is actuated. Release 254 may be actuated, for example, bygrasping handle 260 and release 254 and squeezing release 254 towardhandle 260.

Indicating devices 256 may project onto the surface of a table (such astable 202 shown in FIG. 2). Each of indicating devices 256 may point atan angle relative to the direction that camera 250 is pointed. Forexample, with reference to FIG. 2, each of indicating devices 256 mayproject one of points 259 onto table 202. Points 259 may define thecorners of visual reference zone 261. In one embodiment, indicatingdevices include dot focus lasers. For example, indicating devices may bedot focus lasers, 3.5V-4.5 V 16 mm, 5 milliwatts. Visual reference zone261 may generally correspond to, and provide a visual reference pointsto a technician for, a field of view of camera 250 (which may be, forexample, zone 210). A visual reference zone for a camera may, however,deviate in size, shape, and position from the field of view of a camera.For example, as shown in FIG. 2, visual reference zone 261 is smallerthan zone 210.

FIG. 6 illustrates an embodiment of camera assembly 208 in which cameracase 252 has been removed for illustrative purposes. Camera assembly 208includes camera mount 262 and accessory bracket 264. Camera 250 ismounted to camera mount 262. Camera mount 262, in combination withbearing race assemblies 266, may serve as a carrier for camera 250.Bearing race assemblies 266 are provided at either end of cameraassembly 208. Bearing race assemblies 266 are coupled to camera mount262. Bearing race assemblies 266 include upper bearings 268 and lowerbearings 270. Bearings 268 and 270 may engage a rail (such as rail 206shown in FIG. 2) to facilitate translation of camera assembly 208 on therail. Bearing race assemblies 266 may also be integrated into supportingfeatures molded into the two halves of the protective case.

Circuit board 272 is mounted on camera mount 262 by way of standoffs274. Circuit module 272 may be coupled to camera 250. Circuit module 272includes wireless device 276. Wireless device 276 may include, invarious embodiments, a USB dongle or other wireless antenna (such aswi-fi or Bluetooth). Circuit module 272 may receive image data fromcamera 250 and transmit the data wirelessly to a computer system, suchas computer system 216 shown in FIG. 2. Circuit module may also receivecontrol instructions from a remote computer, for example, over theinternet. Circuit module 272 may also provide control signals to camera250. In some embodiments, circuit module 272 may provide power to camera250.

In some embodiments, an image capture device includes manual triggers.The manual triggers may control functions on the camera. For example,camera assembly 208 includes photo trigger 276 and camera on/off trigger278. Shoot trigger 276 includes photo trigger switch 280 and tactilepushbutton switch 282. Photo trigger switch 280 may be pivotally mountedon pin 281. Manually depressing photo trigger switch 280 may operatetactile pushbutton switch 282. Tactile pushbutton switch 282 may beelectrically coupled to circuit module 272 and/or camera 250.

Camera on/off trigger 278 includes on/off switch 288, pushbutton switch290, cable trigger 284, and cable positioning clamp 286. On/off switch288 may be pivotally mounted on pin 289. On/off switch 288 may actuatepushbutton switch 290. Pushbutton switch 290 may activate cable trigger284. Cable trigger 284 passes through slot 287 on accessory bracket 264.Cable trigger 284 may depress a power on/off button on camera 250. Cablepositioning clamp 286 is mounted on accessory bracket 264. Cablepositioning clamp 286 may be adjusted to position cable trigger 284 atthe proper location to depress the power on/off button. In someembodiments, cable positioning clamp 286 is adjusted to accommodatedifferent models of cameras used for camera 250. Cable position clamp286 may, for example, be adjusted such that cable trigger 284 is alignedwith the on/off button on a particular make of camera.

Although in the embodiment shown in FIG. 6, photo trigger 276 and cameraon/off trigger 278 are operated with hand-operated switches, in certainembodiments, camera control, power on/off, or both, may be carried outusing foot pedals.

Accessory bracket 264 carries gimbal ring assemblies 292. Each of gimbalring assemblies 292 carries a pair of indicating devices 256. Indicatingdevices 256 are mounted in an “eyeball” arrangement such that indicatingdevices can be adjusted to be point in various directions. In oneembodiment, each of indicating devices is positioned at a desired angleto define a visual reference frame on a surface below the camera. Whenindicating devices 256 are in position, set screws 294 may be tighteneddown to lock the positions of indicating devices 256.

FIG. 7 is cross sectional view of a bearing race assembly on a railaccording to one embodiment. Bearing race assemblies may be provided ona camera assembly. Bearing race assembly 266 rides on rail 206. Bearingrace assembly includes race 296, upper bearings 268, and lower bearings270. Upper bearings 268 may engage the curved surface of rail 206. Lowerbearings 270 may engage a flat face 310 of rail 206. Lower bearings 270are supported on screw 298. Screw 298 may be retained by nuts 300. Insome embodiments, nuts 300 are locking nuts (with, for example a nyloninsert). Bushing 302 is provided between bearings 270. Upper bearings268 are carried on set screws 304.

In some embodiments, a bearing system includes an adjustment mechanismfor established desired resistance to translation along a rail. In theembodiment shown in FIG. 7, screw 298 is received in slots 306. Setscrews 308 may be tightened to raise screw 298. Raising screw 298 mayincrease a clamping force on rail 206. In some embodiments, a clampingforce is set when the camera is initially installed on a rail.

In some embodiments, a rail supplies electrical power to an imagecapture device. FIG. 8 illustrates one embodiment of a power connectionbetween rail and a camera assembly. Rail 206 includes outer rail 320,inner rail 322, and insulator 324. Outer rail 320 and inner rail 322 maybe electrically conductive. Positive contact 328 and negative contact330 may be included on camera assembly 208. Positive contact 328 mayengage on inner rail 322. Negative contact 330 may engage on outer rail320. Positive contact 328 and negative contact 330 may slide along theirrespective rail as camera assembly 208 is moved along rail 206. Positivecontact 328 and negative contact 330 may be coupled with, and provideelectrical power to, devices in camera assembly 208, such as circuitmodule 272, camera 250, and indicating devices 256. In some embodiments,the power is a low voltage direct circuit (“DC”) power.

In some embodiments, a rail may includes three or more conductiveelements. Conductive elements on a rail may be isolated from each otherwith an insulating channel. In various embodiments, conductive elementsof a rail may be used to transfer power, data, or provide a ground pathfor electronics.

FIG. 8A is a perspective view illustrating the interior of a passage fora rail according to one embodiment. Positive contact 328 is locatedalong the bottom side of hole 258. Negative contact 330 is located alongthe rear side of hole 258. Positive contact 328 and negative contact 330may be spring contacts. The spring contacts may resiliently engage arail, such as rail 206.

FIG. 9 is an exploded view of a camera assembly. Camera assembly 208includes case top 340 and case bottom 342. Gaskets 344 and 346 areprovided between case top 340 and case bottom 342. Gaskets 344 and 346may at least partially seal the camera case, such as during a cleaningwipe-down. Gasket 344 includes pad 347 and pad 349. Pad 347 may cover onoff switch 288. Pad 349 may cover photo switch 280. Pad 347 and pad 349may inhibit fluids and/or contaminants from passing into camera assembly208 at the apertures for the manual switches, and thereby facilitatecleaning of camera assembly 208 (such as during a wipe-down of thecamera case).

Glass plate 348 is coupled to case bottom 342 with screws 352. Grommets350 may seal the camera case at the mounting location of glass plate348.

Camera mount 262 includes slot 353. Screw 355 may pass through slot 353.Screw 355 may engage in a threaded socket in camera 250 (such as athreaded socket for a standard tripod mount). Screw 355 may beadjustable in slot 353. Adjustment of screw 355 may be used toaccommodate different models of cameras as camera 250.

Release 254 includes arcuate face 364. In some embodiments, arcuate face364 of release 254 bears against the side of rail 206 (for example,under the force of springs 366). When release 254 is engaged against therail, rotation of camera assembly 208 with respect to rail 206 may beinhibited or prevented. In addition, when release 254 is engaged againstthe rail, translation of camera assembly 208 along rail 206 may beprevent or inhibited. Release 254 may be operated by a user to disengagerelease 254 from rail 206.

In some embodiments, an image capture device communicates with acomputer system through a wireless connection. FIG. 10 is a schematicdiagram illustrating one embodiment of a system including an imagecapture device with wireless transmitter/receiver. System 360 includesimage capture device 362. Image capture device 362 may include, forexample, camera assembly 208 described above relative to FIGS. 2-9.Image capture device 362 includes camera 364, laser pointer 366, andcircuit module 368. Circuit module 368 may provide and control power tocamera 364 and laser pointer 366. In certain embodiments, power from acircuit module to a camera may be varied or adjusted. In one embodiment,power is varied to accommodate a different model camera for camera 250.

Circuit module 368 includes wireless transmitter/receiver 370. Wirelesstransmitter/receiver 370 may transmit and receive information to andfrom a corresponding transmitter/receiver 372 on communication device374 over wireless connection 375. Communication device 374 may be, forexample, a personal computer system near a workstation where imagecapture device 362 is being used, or a wireless network hub. Wirelessconnection 375 may be used to transfer control signals or position data(such as whether a manual trigger has been actuated on image capturedevice 362). Wireless connection 375 may also be used to transfer imagedata from camera 364 to communication device 374, which may, in turn,send the image data to remote computer systems such as remote computersystem 378.

Communication device 374 may be connected via network 376 to remotecomputer system 378. Remote computer system 378 may be, for example, acomputer system used by a pharmacist to supervise preparations beingphotographed with image capture device 362. Remote computer system 378may also be used to control the camera directly through the network orcommunication device 374.

Circuit module 368 may receive power from power supply 380. In someembodiments, power may be transmitted to circuit module by way ofconductors in a rail on which the image capture device is mounted, suchas rail 206 described above relative to FIGS. 2-9. Circuit module 368may distribute power to camera 364 and laser pointers 366.

In some embodiments, shooting of an image by a camera may be triggeredby a user either from a computer system input/output device (such as amouse of computer system 374) or by a user-operated switch. Auser-operated switch may be located, for example, on the case of animage capture device, on a foot pedal switch, or in any other location.In some embodiments, the switch is located outside of a clean zone inwhich preparations are made. For example, a user operated trigger may belocated in a foot pedal on the floor of a room outside of a hood inwhich preparations are made. In some embodiments, a switch is a remoteswitch (for example, operated from a device or computer system in adifferent room.

Image capture device 362 includes manual trigger photo switch 380,manual trigger on/off switch 382, and photo upload manual trigger 383.Manual trigger photo switch 380, manual trigger on/off switch 382, andphoto upload manual trigger 383 may be located on a camera case of imagecapture device 362. Manual trigger photo switch 380 may signal circuitmodule 368 to trigger shooting of a photo with camera 364. Alternately,computer system 374 may send a signal to circuit module 368 to triggershooting of a photo. In some embodiments, the control signal from manualtrigger photo switch 380 is passed by circuit module 368 to computersystem 372 over wireless connection 375. Upon receipt of the signal,computer system 372 may return a control signal to circuit module 368over wireless connection 375 for the camera to take the photograph.Photo upload manual trigger 383 may be operable by a user to uploadimages that have been acquired using image capture device 362.

Manual trigger on/off switch 382 may be operated by a user to switchpower on and off in camera 364. In one embodiment, circuit module 366and/or computer system 374 may monitor whether camera 364 is powered up.If camera 364 is powered up, circuit module 366 may activate or maintainpower to laser pointers 366. If camera 364 is not powered up, circuitmodule 366 may place or maintain laser pointers 366 in a powered-offstate. Although in the embodiment shown in FIG. 10, manual triggeron/off switch 382 is directly connected to the camera, a manual poweron/off switch for a camera may in some embodiments operate by sending anelectronic signal to a circuit module. Switch 382 may alternatively bean upload switch (for example, allowing the technician to send the imageto a pharmacist at a remote workstation.)

In some embodiments, an image capture device may be positioned tosequentially capture images of preparations occurring at two or moredifferent locations at a workstation. In one embodiment, the imagecapture device is positioned by translating the image capture devicefrom one position to another. For example, the image capture device maybe slid on an overhead rail, such as rail 206 described above relativeto FIGS. 2-9. FIG. 11 illustrates sequentially capturing image data offor two or more preparations according to one embodiment. At 400, animage of a stage in one preparation is captured at a first zone at aworkstation using an image capture device. At 402, an image capturedevice is moved (for example, translated) such that the image capturedevice points at a second zone. At 404, an image is captured of a stageof preparation for a second preparation that is being prepared at thesecond zone. At 406, the image data is transmitted to a pharmacist forevaluation. At 408, the pharmacist may approve a preparation (or a stepin the preparation) based on the review of the image.

In some embodiments, multiple images may be uploaded to a website orbulletin board as a single post and inclusion of multiple images in asingle post may indicate all of the included images are part of a singlepharmacy task that requires remote supervision and verification.Alternatively, in other embodiments, each of the captured images for asingle pharmacy work task, whether for a medication order or otherpharmacy work, may contain some indication that they are part of thesame pharmacy work task. For example, in one embodiment, each relatedimage could include a unique reference number associated with thepharmacy work task. Reference numbers may be included in captured imagesusing a number of different techniques, according to variousembodiments. For example, in one embodiment, a small piece of paper witha reference number printed on it may be in the view of an image capturedevice when each image is captured. In another embodiment, referencenumbers may be overlayed on, inserted in, or otherwise graphically addedto the captured images. In yet other embodiments, an image capturedevice may be configured to automatically graphically include, add, oroverly reference numbers to captured images. An order identificationnumber from a medication order may be included as a reference number incaptured images, according to one embodiment. In other embodiments,reference numbers may be generated for each set of related images, suchas by an order entry system for entering medication information into apatient's medication profile. In general, any type or sort of referenceindicators, either alphanumeric or graphical, may be used to indicaterelated captured images.

In some embodiments, an image capture device captures an image of astage in a medical preparation. The image may include an identifier codeassociated with the preparation. The identifier code may be, forexample, a semacode or bar code that corresponds to a particularmedication, procedure, or task. In one embodiment, the identifier codeis positioned so that it appears in the same position in all of theacquired images (such as in the lower left corner of the image).

In some embodiments, two or more medications are prepared at differentworkstations, or at different areas of the same workstation. For eachpreparation, an appropriate identifier code may be included in theimages associated with the preparation. The various images required forthe preparations may be captured in any sequence. The identifierinformation may be read from captured images. A computer system mayassociate, reorder, group, or otherwise manage the various images basedon the identifier code information.

In some embodiments, workflow to a pharmacist may be batched. Forexample, one or more preparations at a workstation (or at differentworkstations) may be batched in a first priority batch, and one or moreother preparations at the workstation (or at different workstations orlocations) may be placed in second, lower priority batch, and so on. Apharmacist might evaluate the first priority preparations first, andthen evaluate the lower priority batches in turn. In any of theseexamples, the various priority preparations may be prepared at any giventime, and in any sequence (for example, at different workstations, orusing the movable image capture device described herein). In someembodiments, workflow of the preparations or evaluations may beinterrupted. For example, a pharmacist might stop evaluations for abreak, or be relieved by a pharmacist on a succeeding shift.

FIGS. 12A-12G is a schematic diagram illustrating one embodiment ofacquiring images for multiple preparations at a workstation. Workstation410 includes substations 412A, 412B, and 412C. Image capture device 411is mounted on rail 413. Image capture device 411 may be translated alongrail 413 to sequentially acquire images at workstations 412A, 412B, and412C. When image capture device is at station 412A, image capture devicemay capture an image that includes zone 414A. When image capture deviceis at station 412B, image capture device may capture an image thatincludes zone 414B. When image capture device is at station 412C, imagecapture device may capture an image that includes zone 414C.

In FIG. 12A, preparations are commenced at substation 412A andsubstation 412B. Image capture device 411 may capture an image at afirst stage of preparation at substation 412A. The image at the firststage may include constituents 416A and identifier code 418A.

In FIG. 12B, image capture device is moved from substation 412A tosubstation 412B. Image capture device 411 may capture an image at afirst stage of preparation at substation 412B. The image at the secondstage may include constituents 416B and identifier code 418B.

In FIG. 12C, image capture device is moved from substation 412B back tosubstation 412A. Image capture device 411 may capture an image at asecond stage of preparation at substation 412A. The image at the secondstage may include constituents 416A, syringe 420A, and identifier code418A. Syringe 420B may be pulled back to show, for example, a quantityof saline solution to be used in the preparation. Identifier code 418Ais the same identifier code that was present in the image when an imagewas captured at the first stage of preparation at substation 412A.

In FIG. 12D, a high priority order may be received. The high priorityorder may be, for example, a chemotherapy medication that is urgentlyneeded for a particular patient. A second technician may immediatelycommence preparation at substation 412C. Image capture device may bemoved to substation 412C and an image captured of constituents 416C andidentifier code 418C. In this example, identifier code 418C may includea “STAT” code.

In FIG. 12E, preparation of the high priority preparation is continuedat substation 412C. Camera 411 may remain in position at substation412C. In some embodiments, image data is transferred to a pharmacist ateach stage as soon as the image is taken. The pharmacist may review andapprove the stage before the next stage is commenced. An image may beacquired of a second stage of preparation at 412C that includesconstituents 416C, syringe 420C, and identifier code 418C.

In FIG. 12F, preparation of the high priority preparation is continuedat substation 412C. Camera 411 may remain in position at substation412C. An image may be acquired of a third stage of preparation at 412Cthat includes medicine 422C, vial 424C, label 426C, and identifier code418C.

In FIG. 12G, preparation of the lower priority preparations may bere-commenced at substation 412A. Camera 411 may be moved to substation412A. An image may be acquired of a third stage of preparation at 412Athat includes medicine 422A, vial 424A, label 426A, and identifier code418A. The preparation started at substation 412B may then be completed.

In various embodiments, identifier information, such as identifier codes418A, 418B, and 418C, may be automatically read from preparation images.The identifier information read from the images may be used so that theimages for particular preparations can be associated, grouped, orderedor reordered automatically by a computer system. In the embodimentdescribed relative to FIGS. 12A-12G, for example, the pharmacist mayreview the images taken at substation 412A for all three stages of apreparation as one group, the images for all three stages of apreparation taken at substation 412B as another group, and the imagestaken at substation 412C as a third group. The pharmacist may have theoption of prioritizing the preparations. For example, the pharmacist mayreview and approve the high priority preparation tasks carried out atsubstation 412C before reviewing the lower priority preparation taskscarried out at substations 412A and 412B.

In some embodiments, a foot pedal system is used to capture and useimages of a preparation and associated documentation. One or moredifferent functions may be assigned to each pedal. For example, atechnician may use a foot pedal to select an existing job and to addimages to the job. In one embodiment, a foot pedal assembly includesthree pedals. The user may repeatedly click on the first pedal tosequentially highlight preparation jobs on a list on a computer monitor.The user selects the desired job with the first pedal (for example, byholding the first pedal for a specified duration, such as 3 seconds).When the job is selected, information about the job may come up on themonitor. The first image in the job may be, for example, acomputer-generated medication preparation instruction sheet (compoundingsheet). Once the job is displayed on the monitor, the user may press asecond pedal to add an image to the job. The third pedal may be operatedto send the job to a pharmacist for review.

In some embodiments, a foot pedal may be used to initiate new jobs. Forexample, from the job list page in the example described above, the usermay press the second pedal to initiate a new job and capture an imagefor the new job. The user can use the second pedal to add images to thenew job and the third pedal to send the job to the pharmacist asdescribed above.

In some embodiments, a foot pedal system is used in a manner such that apreparation is completed without the need for paper documents to bebrought into the sterile environment.

In some embodiments, identifier codes in images are used toautomatically check ingredients at a workstation against patientpreparation data. In some embodiments, a computer system uses barcoderecognition to compare an ingredient identifier in an image with anotheridentifier in the image that is associated with a patient, or associatedwith a patient preparation. FIG. 12Y illustrates one embodiment ofverifying ingredients of a patient preparation by comparing barcodes inan image. At 440, a patient label with a barcode and one or moreingredient barcodes are placed at a workstation. For example, in thearrangement shown in FIG. 2A, documentation 228 may include a patientpreparation label with a barcode and documentation 230 may include aningredient label with a barcode.

Referring again to FIG. 12Y, at 442, an image is captured that includesthe patient label with the barcode and one or more of the ingredientbarcodes. At 444, a computer system (such as a server) extracts barcodeinformation from the patient label barcode and one or more of theingredient barcodes. At 446, the computer system uses the patient labelbarcode number to acquire patient medication preparation data from, forexample, an order entry system. The patient medication preparation datamay include the ingredients that should be included in the preparation.At 448, the computer system may use ingredient barcodes (for example, aNational Drug Code (“NDC”)) or a drug barcode database to identify theingredients that are actually at the preparation surface. At 450, thecomputer system may compare ingredients in the image with theingredients acquired from the patient medication preparation data. At452, a determination is made of whether the ingredients actually at thepreparation surface match the ingredients specified in the medicalpreparation data. If the ingredients match, a signal may be given to thetechnician to proceed at 454. If the ingredients do not match, a warningsignal may be generated by the system and sent to the technician, aremote pharmacist, or other persons at 456.

Remote Pharmacist Site:

FIG. 13 illustrates an exemplary workstation used by a pharmacist atremote pharmacist site 110, according to some embodiments. A remotepharmacist workstation may include a computer 500 with one or moremonitors, such as monitors 510 a and 510 b, allowing viewing capturedimages of pharmacy work performed as preparation site 120. According tosome embodiments, a remote pharmacist workstation may include twomonitors 510 coupled to computer 500 to allow simultaneous viewing oftwo images. A remote pharmacist workstation 110 may also have Internetconnectivity for communicating with preparation site 120, according toone embodiment. A remote pharmacist workstation 110 may, in someembodiments, also include, but is not limited to, a scanner 520, aprinter 530, telephone, fax machine, and/or a copier. A remotepharmacist workstation may communicate with one or more preparationsites 120 and/or with system website 130 via an Internet connection,virtual private network, LAN, WAN, or in general any wired or wirelesslink, according to various embodiments.

In some embodiments, more than one pharmacist may be on duty at a singleremote pharmacist site 110 and thus a remote pharmacist site 110 mayinclude more than one remote pharmacist workstation. In such anembodiment, multiple remote pharmacist workstations may be linked via alocal network, such as a LAN or WAN, and each workstation may beconfigured to communicate via an Internet connection provided by thelocal network.

Each remote pharmacist site 110 may have one or more pharmacist on duty,as well as other non-pharmacist support personnel, according to variousembodiments. Any pharmacist that remotely supervises and/or verifiespharmacy functions performed by non-pharmacist personnel at preparationsite 120 from a remote pharmacist site 110 may be required to havelicensure to practice pharmacy in the state in which the preparationsite 120 being serviced is located, in accordance with state laws. Asnoted above, a pharmacy function performed at preparation site 120 maybe remotely supervised and verified by a pharmacist at a pharmacist siteremotely located from preparation sites 120, according to variousembodiments. In general a remote pharmacist site 110 may be in anylocation, including different pharmacy from a pharmacy at thepreparation site. In certain embodiments, a pharmacist located in onepart of an institution may remotely supervise and verify pharmacyfunctions performed in multiple preparation sites 120 (e.g.,institutional pharmacies or teaching institutions) located in otherparts of the same institution. For example, a large institution mayinclude one or more different pharmacy stock areas, or satellitepharmacies, that operate under a single pharmacy license and in someembodiments pharmacy functions performed at satellite pharmacies may beremotely supervised and verified by a remote pharmacist either on dutyin a main pharmacy, a different one of the satellite pharmacies, orlocated offsite. Alternatively, in other embodiments, an institution mayinclude more than one pharmacy and pharmacy functions performed at onepharmacy may be remotely supervised and verified by a pharmacist at adifferent one of the pharmacies.

A remote pharmacist site 110 may even change physical locations overtime, according to some embodiments. For example, in one embodiment, apharmacist working at a remote pharmacist site 110 in Texas may servicepreparation sites 120 in Utah. Such a pharmacist may leave Texas andtravel to another location, perhaps Colorado, and may continue toservice the preparation sites in Utah. For instance, the pharmacist mayleave Texas after a shift of work there, and may arrive in Coloradobefore her next scheduled shift with the preparation sites in Utah.Given the portable nature of modern computer equipment, a pharmacist maytake a remote pharmacist workstation, such as illustrated in FIG. 13,while traveling between remote pharmacist sites 110, according to oneembodiment.

According to some embodiments, a single remote pharmacist site 110 mayservice more than one preparation site 120 and a single preparation site120 may be served by more than one remote pharmacist site 110.Additionally, more than one pharmacist may work at a remote pharmacistsite 110. In general, any pharmacist at any remote pharmacist site 110may remotely supervise and verify pharmacy work performed at anypreparation site 120, according to some embodiments. For example,preparation site 120 may be serviced by one pharmacist at remotepharmacist site 110 a on Mondays and may be serviced by a differentpharmacist, either at the same remote pharmacist site or a differentremote pharmacist site, on Tuesdays. On Wednesdays, preparation site 120may be serviced by a pharmacist at remote pharmacist site 110 b.Additionally, according to one embodiment, preparation site 120 may beserviced by two (or more) different remote pharmacist sites at the sametime while a single pharmacist at a remote pharmacist site may servicetwo different preparation sites at the same time.

According to some embodiments, multiple captured images for a singlepharmacy work task may be included in a single upload or post to awebsite or bulletin board, such as to system website 130. Includingmultiple images in single upload or post may, in certain embodiments,indicate that the images are all related to the same pharmacy work task.Alternatively, in another embodiment, each image may include a referenceindicator that links the materials and documentation displayed to acorresponding pharmacy work task, such as a medication order. Such areference indicator may be an original order, a copy of an originalorder, or a listing containing a unique medication order numbergenerated from the patient's medication profile, such as a completelabel, medication fill list, or a Medication Administration Record,according to various embodiments. The exact nature of such a referenceindicator may vary from embodiment to embodiment or within a singleembodiment. Additionally, any documentation required by policy or lawfor the pharmacy work performed may also be included in captured imagesused for remote supervision and verification. Such documentation mayinclude, but is not limited to, the patient's name, the pharmacylocation, the date and time, and/or the full signature and/or title ofperson performing the pharmacy functions or removing the medication fromthe pharmacy, according to different embodiments.

In some embodiments, a pharmacist may remotely verify pharmacy work viaa real-time collaboration tool. For instance, software may be installedat both an institutional pharmacy site and at a remote pharmacist siteallowing a pharmacist to view in real-time, or near real-time, images ofthe pharmacy work being performed. In one embodiment, a real-timecollaboration tool may include software that interfaces with imagingdevice 210 to allow a non-pharmacist performing pharmacy work at aninstitutional pharmacy to transmit live images of the pharmacy workbeing performed. For example, the institutional pharmacy site and theremote pharmacist site may be connected over the Internet via a customprotocol for viewing remote pharmacy work, such as may be implemented byremote verification software 140 illustrated in FIG. 1. Alternatively,in another embodiment, a live feed from a camera capturing pharmacy workbeing performed may be transmitted to a remote pharmacist usingstandard, off-the-shelf, video conferencing and/or collaborationsoftware. Thus, in some embodiments, a remote pharmacist may supervisepharmacy work as it is being performed. For example, in one embodiment,a remote pharmacist may verify each step as it is performed and mayprovide an indication to a non-pharmacist performing the pharmacy workthat the step was performed correctly. In such an example, the remotepharmacist may provide verification feedback via the same collaborationsoftware, or via another method, such as by telephone.

FIG. 14 illustrates an image captured on image capture device 540 atpreparation site 120 being sent and viewed at remote pharmacist site110, in one embodiment. For example, a nurse, or other non-pharmacypersonnel, at institutional pharmacy Site 120 may enter the pharmacy andcompound a sterile intravenous product that was ordered for a patientafter pharmacy hours and was not available outside of the pharmacydepartment. A pharmacist may have entered the mediation order into thepatient's medication profile and may also have generated a label for theintravenous product via the pharmacy's order entry software. Accordingto one embodiment, after visually inspecting the final product, such asfor particulate matter, the nurse may place the labeled sterileintravenous product, with label and base solution content clearlyvisible, on image capture device 540's display area. Additionally, inone embodiment, one or more of the following items may also be placed ona display area of image capture device 540:

-   -   1. A vial of sterile water, with label (such as a barcode label)        clearly visible, which was used to reconstitute the medication        vial added to the final product.    -   2. A syringe with the plunger pulled back to the marking on the        syringe that indicates the volume of sterile water used to        reconstitute the medication vial.    -   3. The vial of medication that was reconstituted, with label        (such as a barcode label) clearly visible, a portion of which        was added to the final product's base solution.    -   4. A syringe with the plunger pulled back to the marking on the        syringe that indicates the volume of reconstituted medication        that was added to the base solution to prepare the final        product.

If all the items listed above do not reasonably fit on the display area,the nurse may, in some embodiments, capture additional images thatcontain any items necessary to check the work performed. Additionalitems not listed above may also be included in captured images, such asa document with the current date and/or time, her full signature, andtitle, according to one embodiment.

The captured image(s) may be transmitted to system website 130 via anetwork or telecommunication link, according to one embodiment. Imagecapture device 540 may be coupled to computer 550 which itself may becoupled to network 100. In one embodiment network 100 may represent alocal area network providing a connection to the Internet, while inother embodiments, network 100 may represent the Internet to whichcomputer 200 may connect directly. The non-pharmacist worker may logonto system website 130 to upload the captured image(s), in oneembodiment. The captured image(s) may be transmitted from theworkstation at preparation site 120 to system website 130 and may bedownloaded by a workstation at remote pharmacist site 110, according tosome embodiments. In other embodiments, however, captured images may bedirectly transmitted to remote pharmacist site 110, via email forexample. A pharmacist at remote pharmacist site 110 may view thepharmacy work performed at preparation site 120, as well as any otherinformation necessary to conduct process checks and verify that themedication in the captured image(s) was correctly and accuratelyprepared, labeled, compounded, and/or packaged. Examples of informationthat may be included in captured images to allow supervision andverification of pharmacy work and medication removal may include, butare not limited to the following:

-   -   1. Medication labels, solution labels, final product labels.    -   2. Supplies used in compounding the product.    -   3. Equipment indicating volumes used in product preparation.    -   4. Indications of the order in which medications were added        during product preparation.    -   5. Prescriber's order including patient name, drug name, dose,        route of administration, schedule of drug administration, reason        for administration, and signature of the prescriber or his        agent.    -   6. Documentation that includes drug name, strength, lot number,        expiration date, date, time, number of units to be removed from        the pharmacy, worker initials, worker signature and title.    -   7. Auxiliary labels.    -   8. Special storage requirements for medication.    -   9. Drug information references.    -   10. Barcodes.

The above list is only exemplary and that the actual items and/or thenumber of items included in captured images may vary from embodiment toembodiment. The pharmacist may review the captured image(s) on computer500 to verify that the nurse recorded proper documentation for recordkeeping purposes, according to one embodiment.

When remotely supervising and/or verifying pharmacy work performed atpreparation site 120, a pharmacist at remote pharmacist site 110 maydownload one or more captured images from system website 130.Alternatively, captured images may be directly transmitted frompreparation site 120 to remote pharmacist site 110, as described above.The pharmacist may review the medication order entry shown on the imageof the patient's Medication Administration Record in one of the capturedimages. He may also compare it to an image showing the actual pharmacywork performed, and may verify that an order number on the MedicationAdministration Record matches an order number listed on the sterileintravenous product label also shown in the captured image. Thepharmacist may further inspect the captured image(s) to observe one ormore of the following:

-   -   1. The label on the intravenous product is complete and correct        according to the medication order, properly lists the base        solution used, and has been initialed by the nurse.    -   2. The nurse added the correct diluent and the correct and        accurate volume to reconstitute the medication vial.    -   3. The correct medication vial was selected for reconstitution,        and that the correct and accurate volume of the reconstituted        medication solution was added to the final product.    -   4. The intravenous product has a sterile seal on the port        designed for addition of medication.    -   5. There is no obvious particulate matter in the solution, as        seen in the image.

Please note that the above list is exemplary and that the actual stepstaken by a pharmacist when remotely supervising and/or verify pharmacyfunctions may vary from embodiment to embodiment.

The pharmacist may also indicate that the work has been supervisedand/or verified according to the captured images, and is authorized forremoval from the pharmacy or to be placed into regular pharmacy stock,according to one embodiment. A pharmacist may indicate that pharmacywork has been verified in any of a number of different ways, accordingto various embodiments. For example, in one embodiment, a pharmacist maygraphically insert a notation into one or more of the images as anindication that the work displayed in the images has been supervisedand/or verified. Alternatively, a pharmacist may electronically initialone or more of the captured images. In another embodiment, the verifyingpharmacist may create a document referencing the captured images and arelevant pharmacy or medication order and indication that thecorresponding pharmacy work was been verified according to the capturedimages. Such a document may be transmitted to an institutional pharmacyor may be uploaded to and stored on system website 130, according tovarious embodiments.

Additionally, an electronic record or a hard copy of the verifiedcaptured image(s) may be stored at the remote pharmacist site, and/or atsystem website 130. In yet another example, a pharmacist may utilizedigital signature technology to digitally sign one or more of thecaptured images or another document indicating pharmacist verificationof the pharmacy work performed according to the captured images. Inanother embodiment, an indication that the pharmacist verified thepharmacy work according to the captured images may be transmitted topreparation site 120, either directly or indirectly. For example, adocument including such an indication may be emailed or faxed topreparation site 120.

The pharmacist at a remote pharmacist site may also transmit theelectronically notated image(s), or a copy thereof, from remotepharmacist site 110 to preparation site 120 via an Internet connection,virtual private network, or any wired or wireless link, in oneembodiment. This may be done to communicate to non-pharmacist personnelthat the work passed supervision, is verified, and is authorized forremoval from the pharmacy or to be placed into regular pharmacy stock,according to some embodiments. The image may be further notated at thepreparation site 120 and an electronic or hard copy record of thesupervised and verified image may be stored at preparation site 120.

Additionally, at remote pharmacist site 110, the supervised, verified,and pharmacist-initialed captured images, or other document(s)indicating that the pharmacy work was correctly verified, may beprinted, such as on printer 330 and/or transmitted to preparation site120 via facsimile or other method, such as email. The facsimile may bereceived in the pharmacy at preparation site 120. A nurse or otherpersonnel may review the verified documents and verify that it has thepharmacist's initials, which may authorize her to remove the medicationfrom the pharmacy, according to some embodiments. She may write aremoval time on the papers and store them in an appropriate place so thenext pharmacist on duty at the facility may review and/or file thepapers for the pharmacy's records.

If, during the supervision and verification process, a pharmacist atremote pharmacist site 110 discovers, through inspection of the capturedimages, errors in the work performed by the non-pharmacist, thepharmacist may notify both the non-pharmacist who performed the work, aswell as other supervisory personnel, about the errors so that correctivemeasures may be taken, according to some embodiments.

FIG. 15 illustrates one embodiment of a method for remotely supervisingand verifying pharmacy work performed by a non-pharmacist. As describedabove, a non-pharmacist may perform pharmacy work at an institutionalpharmacy for a pharmacy work task requiring pharmacist supervision,verification or both, as illustrated by block 600. For instance, aninstitution, such as a hospital or correctional facility, may not have apharmacist on duty all the time and a patient may require medicationthat can only be obtained through the institution's pharmacy. Thus, anon-pharmacist, such as a nurse or pharmacy technician, may perform thepharmacy functions required to fulfill the order. Pharmacy functionsthat may be remotely supervised and verified include, but are notlimited to, medication preparation, packaging, prepackaging,compounding, and/or labeling of either single unit packages, multipledose packages, in batches or in bulk. The non-pharmacist may capture oneor more images of the pharmacy work, as illustrated by block 610. Imagesof pharmacy work may be captured at various times during the performanceof the pharmacy work, in some embodiments. In other embodiments, imagesmay be captured of the finished medication product and all materials anddocumentation required for the performing the pharmacy work, asdescribed herein above.

The captured images may be transmitted to a remote pharmacist, asillustrated by block 620. Thus, as described above, the captured imagesmay be sent to a remote pharmacist for remote supervision and review, asdescribed above. For example, the images may be sent directly to theremote pharmacist via email, in one embodiment. In other embodiments,the captured images may be uploaded to a website from which the remotepharmacist may download them. Additionally, other documentation may alsobe sent to the pharmacist either by email, uploading to a website, viafax, or by any suitable means. After receiving the captured images, theremote pharmacist may verify the correct performance of the pharmacywork according to the captured images, as illustrated by block 630. Forinstance, the pharmacist may examine the captured images and otherdocuments to ensure that the correct ingredients, materials, andmeasures were used when performing the various pharmacy functions. Ifthe pharmacist is able to conduct process checks and verify that thepharmacy work was correctly performed, she may indicate such byinitialing, labeling, or digitally signing one or more of the capturedimages, according to one embodiment. In other embodiments, thepharmacist may indicate the verification that the pharmacy work wascorrectly performed according to the captured images by creating aseparate verification document or record. The pharmacist may send suchverification to the institutional pharmacy.

The institutional pharmacy may receive an indication of the verificationof the correct performance of the pharmacy work, as illustrated by block640. For instance, the pharmacist may email an indication that thepharmacy work was verified, or alternatively, may upload such anindication to system website 130 from which the institutional pharmacymay download it, according to different embodiments. Alternatively, inanother embodiment, the pharmacist may fax such an indication to theinstitutional pharmacy. After receiving an indication that the remotepharmacist verified the pharmacy work, the medication or other pharmacyproduct produced by the pharmacy work may be further processed orremoved from the work area

In various embodiments, the systems and procedures described above canbe used in an instructional environment. In one embodiment, pharmacytechnician students in a laboratory perform lab activities and captureimages of their work. For example, the students may perform lab modulesinvolving med prep, packaging, etc. The systems used to capture imagesmay include, for example, one or more of the systems described in FIGS.2-10. The student's work may be checked and graded at a later time by apharmacist instructor(s).

As noted above, in some embodiments, a remote pharmacist may remotelysupervise and verify pharmacy functions according to images of theperformed pharmacy work that transmitted directly between a preparationsite and the remote pharmacist. In other embodiments, however,preparation sites and remote pharmacists may use a network addressableserver, such as may be part of system website 130, to communicate andtransfer images and/or other data or documents related to remotelyverifying pharmacy functions. FIG. 16 is a block diagram illustratingthe use of server 700 by preparation site 120 and remote pharmacist site110 for communication and data (image) exchange as part of remoteverification of pharmacy functions. Server 700 may be located atpreparation site 120, remote pharmacist site 110, or at a locationseparate from either preparation site 120 or remote pharmacist site 110,according to various embodiments. Server 700 may be addressable vianetwork 100, which in some embodiments, may be the Internet. In otherembodiments, however, server 700 may be accessible via other methods,such as via a corporate LAN/WAN, direct modem communication, or otherwired or wireless technology. In some embodiments, server 700 may be aweb server, while, in other embodiments, server 700 may be a bulletinboard system allowing posts and retrieval of images and/or otherdocuments. Server 700 may provide security, such as requiring user namesand passwords, or other user authentication, to prevent unauthorizedaccessing of pharmacy related images or information. In general, server700 may utilize any of numerous data and communication securitytechniques, such as encryption, user authentication, HTTPScommunication, etc.

When utilizing a server, such as server 700, for communication relatedto remote verification of pharmacy functions, the non-pharmacistperforming the pharmacy work may upload or transmit one or more imagesof performed pharmacy work (or, alternatively, images of the work as itis being performed), to server 700. For example, in one embodiment,images may be transmitted via FTP or another network file transferprotocol. Server 700 may then store the received images for later accessby a remote pharmacist. In some embodiments, the images may beassociated with a job or task identifier that may be used by apharmacist to reference the images for review.

Server 700 may also provide an interface for review of images bypharmacists, according to some embodiments. For instance, server 700 maynotify the pharmacist that the images have been stored and are availablefor review. Server 700 may also allow the pharmacist to download orotherwise retrieve the images from server 700 for review locally on thepharmacist's computer. Alternatively, in another embodiment, server 700may provide an interface for online reviewing of images. For example,server 700 may generate web pages allowing a pharmacist to view thestored images of performed pharmacy work with a standard web browserprogram without having to retrieve or save the images locally.

After reviewing the images to verify whether the pharmacy work wasperformed correctly, a pharmacist may upload to server 700 an indicationof the verification, according to the images, of the pharmacy workperformed. For example, in one embodiment, the pharmacist may upload acopy of one or more of the images to which the pharmacist's digitalsignature is attached as an indication of the verification of thepharmacy work. In another embodiment, however, the pharmacist may uploada separate document including an indication of his verification of thepharmacy work. In yet another embodiment, server 700 may provide aninterface, such as via generated web pages, allowing a pharmacist torecord on server 700 an indication of the verification of the pharmacywork according to the images.

Server 700 also may, in some embodiments, notify the non-pharmacist thatthe pharmacist has recorded or uploaded an indication of theverification of the pharmacy work. Thus, server 700 may direct thecommunication between the non-pharmacist at the preparation site and theremote pharmacist. Additionally, server 700 may provide an interface forthe institutional pharmacy to access, view, and/or download thepharmacist's indication that the pharmacy work was verified. Server 700may provide an interface allowing a non-pharmacist or institutionalpharmacy to download whatever data or documents were stored on server700 by the pharmacist, according to one embodiment. Alternatively,server 700 may allow personnel at the preparation site, such as aninstitutionally pharmacy, to view data and/or documents from the remotepharmacist site online without having to download and store them locallyat the preparation site. For example, in one embodiment, server 700 maygenerate web pages allowing review of data and/or documents stored onserver 700 by a remote pharmacist.

Using a server, or other shared storage area, for communication betweenan preparation site, and a remote pharmacist may also facilitate reviewand/or supervision of the remote verification process by administratorsor others. For instance, server 700 may provide an interface allowing adirector of an institutional pharmacy to access, examine and/or reviewthe images from the institutional pharmacy as well as any data ordocuments from remote pharmacists. Additionally, server 700 may beconfigured to work in conjunction with other software on workstations atpreparation sites and/or remote pharmacist sites. For example, customsoftware, such as remote verification software 140, configuredspecifically for communication and data exchange as part of remoteverification of pharmacy functions may provide a user interface foruploading, downloading, and/or reviewing images stored on server 700,according to one embodiment.

FIG. 17 illustrates a flowchart for one embodiment of a method for aserver, such as server 700 described above, to facilitate remotesupervision of pharmacy functions, as described herein. For instance,server 700 may receive one or more images of pharmacy work performed bya non-pharmacist at an institutional pharmacy, such as institutionalpharmacy 120, as illustrated by block 800. As noted above, images ofperformed pharmacy work maybe uploaded, posted, or otherwise transmittedto server 700. Server 700 may store the received images for lateraccess, retrieval, and/or review, as illustrated by block 810. Server700 may store received images in any of variety of manners and formats,according to various embodiments. Images may be stored as individualfiles on a file server, as records in an image database, or multipleimages may be compacted and stored together in a single file, such as ina .ZIP file, in some embodiments.

Server 700 may also provide an interface for a remote pharmacist, suchas one at remote pharmacist site 110, to review the images, asillustrated by block 820. For example, in one embodiment, server 700 mayprovide a web interface, consisting of one or more generated web pages,allowing a remote pharmacist to review images using a standard webbrowser program. In another embodiment, server 700 may implement amessaging interface allowing custom software for remote verification ofpharmacy functions, such as remote verification software 140, to sendmessages requesting the storage or retrieval of images, documents orother data. In general, server 700 may allow a remote pharmacist toaccess the images stored on server 700 by an institutional pharmacy.

After reviewing the pharmacy work according to the images, a pharmacistmay record or store on server 700 an indication of his verification ofthe pharmacy work. Thus, server 700 may receive from the pharmacist anindication of verification of the performed pharmacy work according tothe images, as illustrated by block 830. In some embodiments, server 700may provide an interface allowing the pharmacist to record such anindication. In another embodiment, the pharmacist may upload a documentor image including such an indication. For example, the pharmacist mayattach a digital signature or other digital certificate to one or moreof the images and upload the image(s) to server 700 and theinstitutional pharmacy may be able to download or otherwise access thepharmacist's indication. Alternatively, the pharmacist may generate andstore a separate document including an indication of the verification ofthe performed pharmacy work. In some embodiments, such a document mayinclude details of the verification or may include issues or problemsdiscovered in the performance of the pharmacy functions.

Server 700 may, in some embodiments, notify an institutional pharmacy,such as via email or instant messenger, that the pharmacist has finishedreviewing the stored images and has recorded an indication of hisverification of the pharmacy function according to the images.Additionally, server 700 may implement or provide an interface allowingan institutional pharmacy to access and/or review results of thepharmacist's verification. For example, in one embodiment, server 700may allow custom software, such as remote verification software 140 toaccess and/or download the data or documents stored by a remotepharmacist. Alternatively, server 700 may implement a web page basedinterface allowing an institutional pharmacy to review data and/ordocuments stored on server 700 by a remote pharmacist.

FIG. 18 is a block diagram illustrating an embodiment of a computersystem usable to implement remote pharmacy supervision and verification.In some embodiments, a workstation at either preparation site 120,remote pharmacist site 110, system website 130, and/or server 700, mayinclude a general-purpose computer system that includes or is configuredto access one or more computer-accessible media, such as computer system900 illustrated in FIG. 18. In the illustrated embodiment, computersystem 900 includes one or more processors 940 coupled to a systemmemory 910 via an interconnect 950. Computer system 900 may furtherincludes a network interface 930 also coupled to interconnect 950.

In various embodiments, computer system 900 may be a uniprocessor systemincluding one processor 940, or a multiprocessor system includingseveral processors 940 (e.g., two, four, eight, or another suitablenumber). Processors 940 may be any suitable processors capable ofexecuting instructions. For example, in various embodiments, processors940 may be general-purpose or embedded processors implementing any of avariety of instruction set architectures (ISAs), such as the x86,PowerPC, SPARC, or MIPS ISAs, or any other suitable ISA. Inmultiprocessor systems, each of processors 940 may commonly, but notnecessarily, implement the same ISA.

System memory 910 may be configured to store instructions and dataaccessible by processor 940. In various embodiments, system memory 910may be implemented using any suitable memory technology, such as staticrandom access memory (SRAM), synchronous dynamic RAM (SDRAM),nonvolatile/Flash-type memory, or any other type of memory. In theillustrated embodiment, program instructions and data implementingdesired functions, such as those methods and techniques described abovefor remotely supervising and verifying pharmacy functions, may be storedwithin system memory 910 as code 915.

In one embodiment, interconnect 950 may be configured to coordinate I/Otraffic between processor 940, system memory 910, and any peripheraldevices in the device, including network interface 930 or otherperipheral interfaces. In some embodiments, interconnect 950 may performany necessary protocol, timing or other data transformations to convertdata signals from one component (e.g., system memory 910) into a formatsuitable for use by another component (e.g., processor 940). In someembodiments, interconnect 950 may include support for devices attachedthrough various types of peripheral buses, such as a variant of thePeripheral Component Interconnect (PCI) bus standard or the UniversalSerial Bus (USB) standard, for example. In some embodiments, thefunction of interconnect 950 may be split into two or more separatecomponents, such as a north bridge and a south bridge, for example.Also, in some embodiments some or all of the functionality ofinterconnect 950, such as an interface to system memory 910, may beincorporated directly into processor 940.

Network interface 930 may be configured to allow data to be exchangedbetween computer system 900 and other devices attached to a network,such as other computer systems, for example. Network interface 930 maycommonly support one or more wireless networking protocols (e.g.,Wi-Fi/IEEE 802.11, or another wireless networking standard). However, invarious embodiments, network interface 930 may support communication viaany suitable wired or wireless general data networks, such as othertypes of Ethernet network, for example. Additionally, network interface930 may support communication via telecommunications/telephony networkssuch as analog voice networks or digital fiber communications networks,via storage area networks such as Fibre Channel SANs, or via any othersuitable type of network and/or protocol.

In some embodiments, system memory 910 may be one embodiment of acomputer-accessible medium configured to store program instructions anddata as described above. However, in other embodiments, programinstructions and/or data may be received, sent or stored upon differenttypes of computer-accessible media. Generally speaking, acomputer-accessible medium may include storage media or memory mediasuch as magnetic or optical media, e.g., disk or DVD/CD coupled tocomputer system 900 via interconnect 950. A computer-accessible mediummay also include any volatile or non-volatile media such as RAM (e.g.SDRAM, DDR SDRAM, RDRAM, SRAM, etc.), ROM, etc, that may be included insome embodiments of computer system 900 as system memory 910 or anothertype of memory.

The various methods as illustrated in the figures and described hereinrepresent exemplary embodiments of systems and methods. The systems andmethods may be implemented manually, in software, in hardware, or acombination thereof. The order of any method may be changed, and variouselements may be added, reordered, combined, omitted, modified, etc.Additionally, various modifications and changes may be made as would beobvious to a person skilled in the art having the benefit of thisdisclosure. It is intended that the invention embrace all suchmodifications and changes and, accordingly, the above description to beregarded in an illustrative rather than a restrictive sense.

What is claimed is:
 1. A method of making a preparation, comprising:placing a preparation identifier code and one or more ingredientidentifier codes in a work area, wherein the preparation identifier codeis associated with a preparation to be made in the work area or apatient who is to receive the preparation, wherein the one or moreingredient identifier codes are associated with ingredients that are inthe work area; capturing, with a camera, an image of at least a portionof the work area in at least one stage of a preparation, wherein theportion includes the preparation identifier code and at least one of theingredient identifier codes; automatically extracting, with a processor,identifier information from the preparation identifier code and the atleast one ingredient identifier code; automatically comparing, with aprocessor, ingredient information associated with the preparationidentifier code with ingredient information associated with the at leastone ingredient identifier code; determining, with a processor and basedon the comparison, whether ingredient information associated with thepreparation identifier code matches ingredient information associatedwith the at least one ingredient identifier code; and determining, witha processor, whether the correct ingredients are being used for thepreparation, wherein the determination is based, at least in part, onwhether ingredient information associated with the preparationidentifier code matches ingredient information associated with the atleast one ingredient identifier code.
 2. The method of claim 1, whereinthe preparation identifier code comprises a barcode.
 3. The method ofclaim 1, wherein at least one of the ingredient identifier codescomprises a barcode.
 4. The method of claim 1, further comprisingsending a warning if a mismatch is identified between ingredientinformation associated with the preparation identifier code and theingredient information associated with the at least one ingredientidentifier code.
 5. The method of claim 1, wherein capturing an image ofat least a portion of the work area comprises capturing images of two ormore stages of the preparation, wherein the preparation identifier codeand at least one of the ingredient identifier codes are visible in atleast two of the captured images of the two or more stages of thepreparation, the method further comprising associating the at least twocaptured images of the stages of the preparation with one another. 6.The method of claim 1, wherein the images are captured based on atrigger signal received by the camera.
 7. The method of claim 6, whereinthe trigger signal is generated by a user-activated trigger.
 8. Themethod of claim 7, wherein the trigger is a foot pedal.
 9. The method ofclaim 1, wherein the work area is located inside a hood.
 10. The methodof claim 9, wherein the camera is located inside the hood.
 11. Themethod of claim 1, wherein the preparation identifier code and one ormore ingredient identifier codes are national drug codes.
 12. The methodof claim 1, further comprising the steps of transmitting the image andassociated medication record over a computer network to a pharmacist andreceiving an indication over the computer network and from thepharmacist that the proper ingredient was utilized in the preparation.13. The method of claim 1, wherein the processor is programmed orconfigured to generate a warning when the processor determines thatingredient information associated with the preparation identifier codedoes not match ingredient information associated with the at least oneingredient identifier code.
 14. The method of claim 13, wherein theprocessor is configured to generate and transmit a warning to a computerassociated with a pharmacist remote from the work area.
 15. The methodof claim 1, wherein the processor is programmed or configured togenerate an indication to continue making the preparation when theprocessor determines that ingredient information associated with thepreparation identifier code matches the ingredient informationassociated with the at least one ingredient identifier code.